Gates Institute launches new global urban reproductive health program

The Bill & Melinda Gates Institute for Population and Reproductive Health, based at the Johns Hopkins Bloomberg School of Public Health, is launching The Challenge Initiative (TCI), a global urban reproductive health program supported by a three-year, $42 million grant from the Bill & Melinda Gates Foundation.

Managing urban areas and providing essential health services, especially in urban poor settlements, is key to building habitable and sustainable cities. The United Nations projects that the world will be 66 percent urban in 2050, with an additional 2.5 billion more people living in cities — 90 percent of whom will be concentrated in cities in Asia and Africa. Yet despite increasing urbanization, the poorest people living in cities are rarely able to access health information and services.

From 2009 to 2015, the Bill & Melinda Gates Foundation pioneered an Urban Reproductive Health Initiative (URHI) to test a comprehensive approach to improve contraceptive access in select cities in Kenya, Nigeria, Senegal and India. Rigorous evaluation has shown this strategy to be successful, with an increased number of women able to access modern contraception, and even greater improvement among poor women. Progress was especially notable in Senegal and Nigeria, which saw increases in contraceptive use of 12.2 and 11.1 percentage points respectively.

The Challenge Initiative (TCI) will scale up the tools and approaches developed and lessons learned in URHI to more cities and geographies, especially in areas where there continues to be a great need for contraceptive information, supplies and services. TCI is taking an innovative, demand-driven approach: rather than being chosen, participating cities will self-select, and will be asked to bring their own resources (cash or in-kind) to the table. Such cities will work with TCI's in-country partners — called "accelerator hubs" — to develop proposals for implementing a package of family planning interventions that are cost-effective and customized to their urban needs and circumstances. Cities with the most promising proposals will receive technical expertise from the accelerator hubs throughout project implementation and will have access to matching funds from a Challenge Fund seeded by the Gates Foundation and open to contributions from other interested donors.

"TCI represents an exciting new approach to providing life-saving reproductive health and family planning information and services to individuals, families and communities, building on the demonstrated success of URHI. And this year is an apt time for TCI's launch, as it is the halfway point to the Family Planning 2020 goal of enabling 120 million more women and girls to access contraceptives by 2020," says Jose "Oying" Rimon II, MA, director of the Gates Institute.

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Participating cities will also benefit from joining TCI's global community of practice, which will exchange lessons learned and share best practices in delivering health and family planning services to model cities. TCI's approach encourages cities to assume an active role in project design and implementation, while local and global partners take supporting and facilitating roles.

"The future of sustainable development challenges and opportunities will be found in the dynamic growth of cities around the world," says Christopher Elias, MD, President of the Global Development Program at the Bill & Melinda Gates Foundation. "Meeting the growing demand for voluntary family planning, particularly among the urban poor, will allow more women and couples to plan their futures and break the cycle of poverty."

The Gates Institute at the Johns Hopkins Bloomberg School of Public Health is the lead coordinating partner of TCI. TCI's accelerator hubs consist of two Hopkins-affiliated institutions, Jhpiego and the Center for Communication Programs; IntraHealth International, a U.S.-based non-profit; and the India office of Population Services International. An entrepreneurial mindset and healthy competition funding model will be set up so that hubs that are able to line up more cities with competent proposals will receive greater resources to provide technical assistance.

"The Bloomberg School has a long and proud history of advancing public health all over the world, including in the areas of reproductive health and family planning," says Michael J. Klag, MD, MPH '87, dean of the Johns Hopkins Bloomberg School of Public Health, which is celebrating its centennial this year. "This new grant takes an innovative, cities-based approach and will enable the Gates Institute to continue its forward-thinking work to benefit more women, their families and their communities."

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